双孔三通道与传统腹腔镜下精索静脉高位结扎术对比研究

目的:观察双孔三通道与传统腹腔镜精索静脉高位结扎术疗效,探讨双孔三通道精索静脉高位结扎术临床应用价值。方法:2011年1月至2013年3月我院78例(89侧)精索静脉曲张患者,随机分成两组。改良组38例,行双孔三通道腹腔镜精索静脉高位结扎术;传统组40例,行传统腹腔镜精索静脉高位结扎术。对两组患者安全性和临床疗效对比分析。术后3个月观察两种术式切口瘢痕,进行满意度评分。结果:38例患者行双孔三通道腹腔镜精索静脉高位结扎术均顺利完成。手术时间单侧:(21.3±1.5)min;双侧:(32.5±2.3)min],术中、术后并发症,住院时间(3.2±0.3)d vs(3.7±0.7)d]与恢复时间(1天下床率87%vs 78%),症状缓解阴囊疼痛缓解率(73%vs 58%]与精子浓度(26.25±10.22)×106/ml vs(29.13±11.41)×106/ml]、活动率(52.36±9.82)%vs(55.26±11.34)%],与传统腹腔镜组比较无显著性差异(P0.05)。观察术后3个月切口瘢痕改良组明显优于传统组。改良组患者对瘢痕满意度综合评分(2.69±0.32)分],与传统腹腔镜组(1.27±0.21)分]比较差异有显著性(P0.05)。结论:双孔三通道腹腔镜精索静脉高位结扎术安全、微创、美观、经济、简便,是可选手术中较为理想的术式,值得临床推广。

Two-port three-trocar versus conventional three-port laparoscopic high ligation of the spermatic vein in the treatment of varicocele

Objective： To compare the effects of two-port three-trocar and conventional three-port laparoscopic high ligation of the spermatic vein and investigate the application value of the two-port three-trocar option in the treatment of varicocele. Methods：Totally,78 patients with varicocele（ in 89 sides） were randomly assigned to receive modified two-port three-trocar laparoscopic high ligation（ group A,n = 38） and conventional three-port laparoscopic high ligation of the spermatic vein（ group B,n = 40）. Comparisons were made on the safety and clinical effect of the two surgical options as well as on the scar formation and patients＇ satisfaction at3 months after operation. Results： All operations were completed successfully. No significant differences were observed between groups A and B in the operation time（ unilateral： 21. 3 ± 1. 5] vs 22. 8 ± 2. 6] min; bilateral： 32. 5 ± 2. 3] vs 33. 2 ± 1. 9]min）,postoperative complication（ 0% vs 0%）,1-day bed confinement（ 87% vs 78%）,hospital stay（ 3. 2 ± 0. 3]vs 3. 7 ± 0. 7]d）,scrotal pain relief（ 73% vs 58%）,sperm concentration increase（ 26. 25 ± 10. 22]× 10^6/ml vs 29. 13 ± 11. 41]× 10^6/ml）,and sperm motility improvement（ 52. 36 ± 9. 82]% vs 55. 26 ± 11. 34]%）（ all P 〉0. 05）. Three months after surgery,the incision scar was significantly smaller,with remarkably higher cosmetic scores in group A than in B（ 2. 69 ± 0. 32 vs 1. 27 ± 0. 21,P 〈0. 05）. Conclusion： Two-port three-trocar laparoscopic high ligation of the spermatic vein,with its advantages of safety,minimal invasiveness,good cosmetic effect,and simple operation,is an ideal surgical option for the treatment of varicocele and therefore deserves clinical popularization.